BIAS AND GENERALIZABILITY IN MEDICARE-BASED ANALYSES ACROSS THREE POLICY PERIODS

Abstract Administrative Big Health data such as that drawn from the Medicare program is an invaluable resource for the study of population health. Although the Medicare program provides near universal health coverage for older U.S. adults age 65+, for most types of care data is collected only for individuals enrolled in traditional Medicare (TM) plans, with those enrolled in private Medicare Advantage (MA) plans being effectively censored in terms of the extent of available data. This presents two potential problems for health outcomes research: bias and generalizability. In this study we use Health and Retirement Study data (1998-2015) to assess the presence and magnitude of group-specific differences between MA and TM beneficiaries as well as plan switchers across three policy-specific periods (Balanced Budget Act; Medicare Modernization Act; Affordable Care Act). We found that the MA population was characterized by higher diversity, adverse behavioral habits, lower education, and economic disadvantage. Initially, lower morbidity levels converged with the TM average over time. Individuals, switching into MA after TM had much larger morbidity levels and mortality risk than any other Medicare group. We found significant loss of generalizability with respect to the Hispanic population; such estimates could be further biased to the extent that MA Hispanics differ from TM Hispanics. Of great concern is the combination of low education and low economic status in MA beneficiaries – a combination also found in many disadvantaged minorities. Care is needed in the design of TM-based studies, especially those focused on ethnic differences.

to navigate and was not 'intuitive'.In navigating the online database, the older adults identified multiple discrepancies with established guidelines for designing age-friendly websites.A total of 187 local physical activity programs were missing from the database.Findings provide novel insight into user experiences of older adults navigating online health and physical activity program websites.Redesign following age-friendly website recommendations would empower older adults in use of online databases and promote awareness of local physical activity programs.Health care providers need reliable and age-friendly online resources to link their patients with local physical activity programs to promote healthy aging.

AGE-BASED ENTITLEMENT: AN AGEIST PRACTICE OR A TOOL FOR COMBATTING AGEISM?
Tove Harnett 1 , and Håkan Jönson 2 , 1. Lund University,Lund,Skane Lan,Sweden,2. Lunds Universitet,Lund,Skane Lan,Sweden Researchers in gerontology have addressed the way age-based arrangements may communicate stereotypical and devaluing images of older people, thereby linking high age to frailty and dependence.The present article considers proposed reforms to the Swedish eldercare system designed to guarantee people over 85 the right to move into a nursing home regardless of their needs.The purpose of the article is to investigate older people's views on agebased entitlement in light of this proposal.What might the consequences of implementing the proposal be?Does it communicate devaluing images?Do the respondents consider it a case of ageism?The data consists of 11 peer group interviews with 34 older individuals.Bradshaw's taxonomy of needs was used to code and analyze data.Four positions on the proposed guarantee were identified: care should be arranged: (1) according to needs, not age; (2) according to age as a proxy for needs; (3) according to age, as a right; and (4) according to age, to combat "fourth ageism", meaning ageism directed towards frail older persons with care needs, i.e. persons in the fourth age .The notion that such a guarantee might constitute ageism was dismissed as irrelevant, while difficulties in getting access to care were presented as the real discrimination.It is theorized that some forms of ageism posited as theoretically relevant may not be experienced as such by older people themselves.
Administrative Big Health data such as that drawn from the Medicare program is an invaluable resource for the study of population health.Although the Medicare program provides near universal health coverage for older U.S. adults age 65+, for most types of care data is collected only for individuals enrolled in traditional Medicare (TM) plans, with those enrolled in private Medicare Advantage (MA) plans being effectively censored in terms of the extent of available data.This presents two potential problems for health outcomes research: bias and generalizability.In this study we use Health and Retirement Study data (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) to assess the presence and magnitude of group-specific differences between MA and TM beneficiaries as well as plan switchers across three policy-specific periods (Balanced Budget Act; Medicare Modernization Act; Affordable Care Act).We found that the MA population was characterized by higher diversity, adverse behavioral habits, lower education, and economic disadvantage.Initially, lower morbidity levels converged with the TM average over time.Individuals, switching into MA after TM had much larger morbidity levels and mortality risk than any other Medicare group.We found significant loss of generalizability with respect to the Hispanic population; such estimates could be further biased to the extent that MA Hispanics differ from TM Hispanics.Of great concern is the combination of low education and low economic status in MA beneficiaries -a combination also found in many disadvantaged minorities.Care is needed in the design of TM-based studies, especially those focused on ethnic differences.

INTERROGATING AGEISM Douglas Hanes, Stony Brook University, Stony Brook, New York, United States
This paper identifies and addresses a puzzle within the conceptualization of ageism.According to the Reframing Aging Initiative, "Ageism refers to stereotypes, prejudice, and discrimination directed toward people on the basis of age"; these adversely affect older people's lives in daily lives, including in employment and healthcare.Yet, unlike other marginalized groups, like people of color and women, older people are not underrepresented in powerful positions nor are they worse off.Indeed, they tend to fare better than the population overall: the mean age of US CEOs is 59 years; US Representatives and Senators are 58.4 and 64.3, respectively.Older Americans are more likely to be homeowners and less likely to be unemployed or food-insecure than the overall population.This paper considers several possible explanations.First, unlike racism or sexism, ageism may not be structural, but personal: present in individuals' attitudes and interactions, but without population-level effects, codification, or institutionalization. Second, ageism may only hold intersectionally, becoming operational under conditions of structural oppression like racism and sexism.For example, while older US whites have less risk of food insecurity than younger whites, older Black Americans are at greater risk than younger Blacks.Finally, ageism may be mitigated by selective mortality: while older people face ageism daily, not everyone reaches older age.Wealthier people and whites are more likely to live to older age; older people's greater power and welfare reflect their earlier status.Each option presents benefits and drawbacks; together they allow us to address those whom ageism most harms.

RETIRING TO POVERTY: VETERANS' PROTESTS FOR NONPAYMENT OF PENSIONS IN NIGERIA
Runcie Chidebe 1 , Agha A. Agha 2 , Ejike Ugwu 2 , Donnette Narine 3 , Takashi Yamashita 4 , and Phyllis Cummins 1 , 1. Miami University, Oxford, Ohio, United States, 2. University of Nigeria Nsukka, Nsukka, Enugu, Nigeria, 3. University of Maryland Baltimore, Baltimore, Maryland, United States, 4. University of Maryland, Baltimore County, Baltimore, Maryland, United States The lack of satisfactory retirement plans coupled with poor retirees' well-being has led to the introduction of different pension and social security policies in Nigeria.Of all the public servants impacted by the weak pension system, Nigerian veterans are the most vulnerable.Veterans spent their youthful years serving the nation and defending its territory; however, when they retire, they retire to poverty.Since 2015, Nigerian veterans have been staging protests and blocking access roads for non-payment of pensions, gratuities, and other allowances.We adopted a qualitative research approach and used content analysis to examine 45 news articles (2015-2022) related to veterans' protests for non-payment of pensions in Nigeria.A semi-structured interview was conducted with ten veterans.Our findings show the protests were perceived as the last resort to 'save their lives' from poverty and ill health.Non-payment of pensions to veterans in Nigeria has a negative sociopsychological impact on the veterans, their families, and the country.Some of the protest placards read: "We have sacrificed our youthful years fighting for Nigeria, we should be celebrated', "When we remember the dead, we should also remember the living".Some quotes from the interviews are: "We're here, alongside our wives and children, and the widows of late military personnel and veterans who died in service, some of whom died fighting Boko Haram terrorists.We'll be sleeping over at this place until they…accede to our demands."Veterans organize themselves in diverse groups.Our findings provide evidence to support improved pensions for veterans in Nigeria.

SOCIAL PRESCRIBING FOR THE ARTS: LESSONS FROM ABROAD FOR THE HEALTH CARE OF OLDER AMERICANS
Shayna Gleason 1 , Sudha Shreeniwas 2 , and Joy Birabwa 3 , 1. University of Massachusetts,Boston Gerontology,Boston,Massachusetts,United States,2. University of North Carolina Greensboro,Greensboro,North Carolina,United States,3. University of North Carolina at Greensboro,Greensboro,North Carolina,United States Evidence shows the dramatically positive influence of participation in the arts on the health and well-being of older adults (OA).Social Prescribing for the Arts (also called Arts on Prescription or AoP) -in which a professional in a clinical or community setting refers a client to the arts and supports them in accessing arts